Abstract

Management of neonatal chylothorax: Twenty years’ experience in a single tertiary Neonatal Unit

Presented at the Neonatal Society 2018 Summer Meeting.

Sharp H, Kortsalioudaki C, Sellwood M, Kendall G

Academic Neonatology, Institute for Women’s Health, University College LondonNeonatal Unit, University College Hospital, London

Background: Neonatal chylothorax (NC) is a rather rare but life-threatening condition characterised by the accumulation of chyle in the pleural space. It is associated with significant morbidity and mortality. Therefore, it requires timely diagnosis and treatment.Currently its natural course is not well described and there are no standardised, approved guidelines for its management. This study aimed to review the underlying aetiology, clinical course, management and outcomes of neonates with NC.

Methods: We conducted a retrospective review of case notes of all neonates with NC admitted to a tertiary level neonatal unit over the period 1997-2017.

Results: Twenty-five NC cases were identified, of which 14 were spontaneous, 5 had a genetic cause and 6 were iatrogenic. Fourteen cases were diagnosed antenatally of which 6/14 underwent antenatal pleural drainage. All cases required pleural drainage postnatally for 25.4 (16-36) days. On average, neonates with NC were ventilated for 9 (0-197) days after birth. Median length of hospital stay was 62 (12-251) days, with median time to full enteral feeds to be 37 (6-118). Seventeen neonates were trialled on breast-milk; however, in all cases this was stopped due to recurrence or worsening of chylothorax. At discharge, twenty neonates required a medium chain triglyceride (MCT) formula. Octreotide was used in 11/25 infants with persistent NC. For 5 of them it was successful in reducing chest-drain output, however 4 were equivocal and 2 resistant to treatment. Surgery for chylothorax was required in 2 cases in our cohort. Three neonates died.

Conclusion: Neonates with NC require prolonged periods of intensive-care and hospitalisation. Early introduction of EBM was unsuccessful with the vast majority of neonates being discharged on MCT. Octreotide administration had varied success. We believe this to be of value when counselling parents and planning appropriate care.